June 2018 | Issue 36

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Class of 2018 looks to the future

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Anne Loh and Sean Firoz, Communications and External Relations

Five years ago, the inaugural cohort of NTU Singapore's newly minted Lee Kong Chian School of Medicine (LKCMedicine), the Class of 2018, entered the MBBS programme with stars in their eyes, excited at embarking on a fresh, new adventure that would see them graduate from an innovative MBBS programme that places patients at the centre of their care. That promise and potential have become reality as they take up positions as house officers and residents in seven hospitals across Singapore, not only those that are part of LKCMedicine's primary healthcare partner, the National Healthcare Group (NHG).

A curriculum such as LKCMedicine's where early patient contact, team-based teaching, clinical electives and an intensive 10-week Student Assistantship Programme (SAP) in Year 5 may go a long way towards ameliorating the first day of Post Graduate Year 1 (PGY1), but the feelings of the young doctors starting out are mixed, nonetheless.

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With bright eyes, the inaugural cohort wrapped up their five years of study at LKCMedicine and looked forward to their postings to various hospitals around Singapore

"I felt differing emotions – excitement, anticipation and some uncertainty," said Claudia Tong, serving her PGY1 in Khoo Teck Puat Hospital, on her medicine rotation. "All this got shoved aside almost immediately as we dived straight into preparing the morning list, ordering scans, organising medications and requesting blood tests. It was a brand-new experience with new responsibilities and expectations thrust upon us."

Charmaine Lee, who is currently​ doing her internal medicine rotation in Tan Tock Seng Hospital (TTSH)​, echoed these sentiments, "I started in the Renal Department which seemed rather daunting as patients can have a lot of comorbidities and vein issues. It was a steep learning curve but the kindness and patience shown to us helped us so much in the learning process. The patient's care and experience depends a lot on what you do and what you don't do."


The Challenges

Fresh off the LKCMedicine boat, the young doctors are expected to be quick on their feet and efficient, prescribing medications to patients, writing up discharge summaries and discussing how best to treat a patient with the medical team. Although there's much to absorb on the job, the PGY1s are thankful for the guidance of the medical team and their seniors to help them adapt to life on the wards.

"It is really great to be part of a bigger team, especially when the team is nice and has great camaraderie," said Delwyn Lim, an NHG​ Internal Medicine resident who is currently posted to TTSH's Department of General Surgery. "Decisions are made together and I can consult with my colleagues if I'm unsure of things."

Still, having been trained to put the patient front and centre, the responsibility on the shoulders of the young doctors should not be underestimated. "Personally, the biggest challenge for me is to reflect on things I could have done better and how I can improve my practice in the future rather than flagellate over every mistake," says Charmaine.

Stewart Retnam, who is currently on his orthopaedics rotation at Singapore General Hospital, added, "I cannot under​state the amount of responsibility every house officer is imbued with from the first day onward. Many lives – human lives – are entrusted in our hands, hands that wield the power to order literally nearly any test and medication available in the hospital."

The PGY1s were quick to learn the importance of prioritising their workload and being efficient in what they do. Through their housemanship, the PGY1s hope that the training and difficulties they face will help them become more confident in managing patients and be better doctors. "Starting work helped me better understand how essential it is to have good teamwork with all medical and non-medical healthcare staff. Everyone plays a big role in the patient's care. And being able to see the strengths of each person allows you to better plan when to involve each person to speed up the inpatient stay such that the patient goes home well and stable in a shorter period of time," says Charmaine.

It may not take a village but it does take entire teams to provide care to a patient on their healthcare journey, a point LKCMedicine instils from day one. The new doctors are now appreciating the bigger picture. "I am particularly thankful to the nurses who have been thoroughly helpful and even supportive when we faced challenging patients and families. I have also gotten more exposure in working alongside physiotherapists, occupational therapists, speech therapists, dieticians, care coordinators and medical social workers as many of my current patients in neurosurgery have multiple care issues and require a concerted effort from all of us as a healthcare team," says Claudia.

Working on the wards can prove to be a demanding and stressful environment.

"One of my personal mantras I try to abide to is to take care of myself so that I have the energy and strength to take care of my patients optimally. Thus, I make it a point to at least grab a quick bite before going for each call duty, and constantly hydrate myself," said Leon Tan, who is currently doing paediatrics in KK Women's and Children's Hospital (KKH) for his PGY1.

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With a great team of seniors and house officers by his side, Leon (second from left) enjoys his time at the paediatrics ward in KKH ​​(photo credit: Leon Tan)

Doctors should always take care of themselves no matter how busy they can get. How can doctors take care of others when they can't take care of themselves?

When asked about the feedback for the PGY1s, Assistant Dean for Year 5 and Lead for Emergency Medicine Associate Professor Tham Kum Ying said, "The new doctors are adapting well – they have settled into their first postings and learned to take on responsibilities for their patients, as members of their clinical teams and for their own growth as clinicians."


Proof of the LKCMedicine training

This is only the beginning for the 52 doctors, embarking on a career to be doctors you and I would like caring for us. Having already been in the job for a month or so, the young doctors looked back at how LKCMedicine has helped them prepare for this journey.

"LKCMedicine really prepared us extremely well in terms of communications, especially with patients, their families and taking a good and comprehensive medical history," said Leon.

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Spending 5 years together through thick and thin, Senior House Tutor Asst Prof Jeeve Kanagalingam and his students from the inaugural cohort have grown closer than ever before​

Delwyn agreed that good communication skills are extremely important, especially when soothing the fears and frustrations of the patients and their families. The SAP also gave the doctors a step up into the real world, giving them a taste of what being a house officer is like. This is also to ensure that they do not get caught off guard during their first day of work, according to Claudia.

"I am thankful that LKCMedicine organised our SAP posting to be as close to reality as possible. The consultants expected us to function fully as HOs when we were on the SAP, so life as a HO would not be that much of a surprise to us," said Claudia.


Hopes for the future

The new doctors are confident though. "The full experience of it only hits you when you are in PGY1. I hope it trains us to be more confident in managing patients with a wide range of medical and surgical issues, to be conscientious in looking into how we can improve our management of their comorbidities. On the non-medical aspect of things, I would of course hope to come out stronger as an individual," says Claudia.

A/​Prof Tham has this advice for them, "Cherish the learning opportunities in your day-to-day work, as experience is built one patient at a time, and one day at a time."

LKCMedicine wishes them the best of luck in their future, and may they shine as amazing doctors who will serve the people of Singapore well!